Basic Information
Provider Information | |||||||||
NPI: | 1255771150 | ||||||||
EntityType: | 1 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: |   | ||||||||
LastName: | LOPEZ | ||||||||
FirstName: | CORAL | ||||||||
MiddleName: |   | ||||||||
NamePrefix: |   | ||||||||
NameSuffix: |   | ||||||||
Credential: | M.D. | ||||||||
OtherOrganizationName: |   | ||||||||
OtherOrganizationType: |   | ||||||||
OtherLastName: |   | ||||||||
OtherFirstName: |   | ||||||||
OtherMiddleName: |   | ||||||||
OtherNamePrefix: |   | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: |   | ||||||||
OtherLastNameType: |   | ||||||||
Mailing Information | |||||||||
Address1: | HOSPITAL PEDIATRICO | ||||||||
Address2: | CENTRO MEDICO BARRIO MONACILLOS CARRETERA 22 | ||||||||
City: | SAN JUAN | ||||||||
State: | PR | ||||||||
PostalCode: | 009350001 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 7877773535 | ||||||||
FaxNumber: |   | ||||||||
Practice Location | |||||||||
Address1: | CARR 189 KM 2.0 | ||||||||
Address2: | PARQUE INDUSTRIAL CAGUAX | ||||||||
City: | CAGUAS | ||||||||
State: | PR | ||||||||
PostalCode: | 00775 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 7877773535 | ||||||||
FaxNumber: | 7877463848 | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 06/25/2013 | ||||||||
LastUpdateDate: | 07/08/2021 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: | F | ||||||||
AuthorizedOfficialLastName: |   | ||||||||
AuthorizedOfficialFirstName: |   | ||||||||
AuthorizedOfficialMiddleName: |   | ||||||||
AuthorizedOfficialTitleorPosition: |   | ||||||||
AuthorizedOfficialTelephone: |   | ||||||||
IsSoleProprietor: | Y | ||||||||
IsOrganizationSubpart: |   | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: | 06/14/2021 |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2080P0205X | 21823 | PR | Y |   | Allopathic & Osteopathic Physicians | Pediatrics | Pediatric Endocrinology |
No ID Information.